razieh akbari

The positive effects of growth hormone (GH) on the endometrium, including increased endometrial blood supply and enhanced expression of cytokines associated with endometrial receptivity, have been noted. However, data on the effect of GH on the endometrium remain limited.

This study aimed to investigate the effect of intrauterine administration of GH on the IVF success rate in women with recurrent implantation failure (RIF).

This randomized double-blind clinical trial was conducted on 60 infertile women under 40 years old with a Body Mass Index (BMI) below 30 kg/m², all diagnosed with RIF—defined as at least three failed pregnancies after transferring a minimum of four good-quality embryos due to unknown causes. Women with uterine malformations, Asherman syndrome, cavity-distorting lesions, severe endometriosis, or other underlying diseases were excluded. After six days of estrogen therapy, transvaginal ultrasound (TVS) was performed to measure and compare the thickness and quality of the endometrium. Participants were divided into two groups. In the intervention group, 10 units of GH were administered using an IUI catheter positioned one centimeter above the cervical os. Study outcomes included changes in endometrial thickness (ET) and quality, as well as pregnancy rates. Primary endpoints were changes in ET and quality, while secondary endpoints were pregnancy rates. Adverse drug responses were also evaluated.

The mean age was 34.96 ± 4.04 years, and the mean BMI was 24.89 ± 2.91 kg/m², with no significant differences in baseline variables between the study groups. The average ET on the 8th day of the cycle was 5.38 ± 0.96 mm in the intervention group and 5.20 ± 0.80 mm in the control group, showing no significant difference (P = 0.467). The ET on the day of initiating progesterone was 7.60 ± 1.03 mm in the intervention group and 7.40 ± 0.60 mm in the control group, with no significant difference (P = 0.264). The odds ratio for achieving a high-quality endometrium was 2.37 (95% CI 0.80 - 6.98, P = 0.116) for the GH group compared to the non-GH group. The odds ratio for achieving a clinical pregnancy was 3.06 (95% CI 0.54 - 17.37, P = 0.205) for the GH group compared to the non-GH group. Two cases of cervicitis were reported in the GH group.

Intrauterine administration of GH appears to enhance endometrial receptivity in women with RIF.

This study aimed to assess ophthalmic artery Doppler in combination with N-terminal prohormone of Brain Natriuretic Peptide in the prediction of pre-eclampsia (PE) at 28-32 weeks’ gestation.

This is a prospective study on singleton pregnant women who were referred to Imam Khomeini Hospital for routine pregnancy care at the gestational age of 28 to 32 weeks from June 2023 to June 2024. The mother's demographic information, medical history, bilateral ophthalmic artery Doppler, and NT-proBNP levels were recorded. Area under the curve (AUC) and logistic regression models were used to analyze the data.

Resuls:

 One hundred sixty pregnant women with a gestational age of 28-32 weeks were included, and 36 (22.5%) of them developed PE. The averages of PSV ratio in the PE pregnancies were 0.60±0.12, and in the normal pregnancies were 0.75±0.09. The average PSV ratio in the PE pregnancies was significantly higher than in normal pregnancies (P< 0.001). Also, the average PSV2 in PE pregnancies was significantly higher than in normal pregnancies (P < 0.015). The frequency of fetus death was higher in the PE pregnancies (P = 0.041). The ROC curve for PSV ratio in the prediction of PE showed that 0.69 was the best cut-off value of PR (sensitivity 0.83; specificity 0.81). The regression model for the development of PE revealed a significant association only with the PSV ratio (p = 0.016).

 At 28–32 weeks of pregnancy, the ophthalmic artery PSV ratio was found to be helpful in predicting future PE development, especially preterm PE. It could be valid on its own or in combination with other biomarkers. The mean of NT-proBNP in PE pregnancies was higher than in normal pregnancies. However, the differences were insignificant, and this insignificant difference in this study may be related to differences in the evaluation of participants during gestation weeks and differences in population samples between studies. More studies are needed to assess this biomarker in combination with ophthalmic artery Doppler to predict PE.

Genitourinary syndrome of menopause (GSM) is a common complication secondary to estrogen depletion which leads to tissue changes in the female genitourinary tract. Here, we sought to investigate the short- and long-term effects of CO2 laser therapy on symptoms of GSM in postmenopausal women.

In this clinical trial, 47 postmenopausal women with symptoms of GSM were included. Participants underwent vaginal and extra-vaginal CO2 fractional laser treatment in three sessions, with intervals of one month between each session. Symptom severity, including itching, dyspareunia, vaginal discharge, and dryness, was assessed at each session using a modified Vaginal Health Index (VHI), where the intensity was rated on a Visual Analog Scale (VAS) from 1 to 10 (1 indicating minimal symptoms and 10 representing maximum severity). Additionally, the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) was administered. Patients were followed for one to three years after the final laser treatment session.

The scores of all subscales, including itching, dyspareunia, urinary incontinence, vaginal discharge, and dryness, improved significantly following three sessions of CO2 fractional laser (p values < 0.001). However, except for the urinary incontinence domain (P = 0.058), none of the symptoms maintained improved after one to three years from the last intervention.

CO2 fractional laser treatment is appropriate for treating symptoms related to GSM. But it seems that it needs to be used continuously for the maintenance effect on itching, dyspareunia, urinary incontinence, vaginal discharge, and dryness. The exact timing of laser sessions should be identified in further studies since the beneficial outcomes of the intervention seem temporary.

The research combined different bibliometric techniques to analyze systematically recurrent pregnancy loss (RPL) documents from 1970 to 2023.

Overall, 1287 documents from the Web of Science database associated with recurrent pregnancy loss between 1970 and 2023 were identified for more than 300 journals. The data were analyzed with VOSviewer software.

The trend of paying attention to the topic of RPL can be divided into three periods. The number of publications on RPL increased significantly after 2010. Most of the papers were published in Obstetrics and Gynecology and Reproductive Biology areas. Utilizing co-occurrence and co-citation analysis, our study found that the most influential documents mapped the knowledge structure, and projected future research directions. The co-occurrence analysis showed five clusters even though the co-citation analysis designates four.

RPL has increased in recent years exponentially and some areas were explained carefully, therefore these results could be used as a research agenda for the future direction by a range of interested beneficiaries.

Despite the high efficacy of the Apgar score in finding respiratory distress, a low Apgar score doesn’t necessarily indicate fetal hypoxia-asphyxia. Umbilical Artery pH (UApH) is one of the best indicators of fetal hypoxia. Therefore, it’s so beneficial to consider these criteria and their relationship with the Apgar score for accurate diagnosis of prenatal respiratory distress retrospectively which reduces the unnecessary cesarean section (CS) rate.

162 full-term (≥259 days) neonates delivered by CS with the diagnosis of decreased fetal heart rate (FHR) were evaluated. 1-min and 5-min Apgar scores and UApH were measured. The correlation between Apgar scores with UApH and the association between UapH and Apgar with the NICU admission were evaluated. The effect of other variables including mother’s age, gravidity, gestational age, birth weight, newborn sex, and causes of decreased FHR on Apgar scores and UApH were studied as well.

The most common cause of decreased FHR was fetal distress, boys had higher weight (P=0.033) and lower UApH (P=0.049) than girls. Other parameters were not different significantly between both sexes. There was a positive correlation between UApH and 1-min and 5-min Apgar scores (r=0.464 and r=0.370 respectively) when controlled for birth weight (P<0.0001). The RR for NICU admission in male acidemic neonates with abnormal 1-min Apgar was 14.05 (CI95%: 5.7-34.6) in comparison to females (RR=1.06, CI95%: 1-1.26).

Mild acidemia (UApH<7.2) at least in a male fetus would be a good predictor for postnatal complications and need for NICU admission. Future studies with more samples are suggested.

The purpose of this study was to compare the effectiveness of Buccal, Vaginal, and Sublingual misoprostol for induction of labor in term pregnancy.

The research was done as an RCT from 2017 to 2018. About 300 participants were randomly allocated to obtain 50 µg Buccal, 25 µg Vaginal, and 50 µg Sublingual misoprostol in Kosar Hospital, Qazvin, Iran. The maternal and fetal complications, Bishop score hour 1, and hour 6 were observed.

There were no differences between fetal complications (p>0.05) and maternal complications (p>0.05) among the three groups. Bishop score hour 1 (P = 0.146), Bishop Score hour 6 (P = 0.704), and total dose (P = 0.15) also were no differences among these groups. Our study found a difference between the three groups (P = 0.015) in achieving standard vaginal delivery within 24 hours, as Buccal, Sublingual and Vaginal groups were performed respectively. The use of Oxytocin in the Buccal group was higher than that of other groups (P = 0.022).

This study found that there is no difference in terms of fetal complications and maternal complications in the three groups, but there was a significant difference in Oxytocin use and vaginal delivery within 24 h from the start of induction.

To investigate the association between intimate partner violence during pregnancy and maternal and neonatal outcomes.

This cross-sectional study was performed on 115 pregnant women referring to an academic center. Demographic data, maternal outcomes (vaginal bleeding during pregnancy, preterm delivery, intrauterine growth restriction, placental abruption, and premature rupture of membrane), and neonatal outcomes (birthweight and Apgar score) were evaluated. Domestic violence against pregnant women was ascertained by a validated domestic violence questionnaire. Finally, the association between domestic violence and maternal and/or neonatal outcomes was investigated.

The prevalence of domestic violence against pregnant women was 67.8%. Psychological violence obtained the highest prevalence (64.3%), followed by economic (34.8%), sexual (18.3%), and physical (12.2%) violence. Regression analysis showed that there was a significant association between domestic violence and preterm labor (P = 0.048, r = 0.385) and between economic violence and placental abruption (P = 0.040, r = 0.391). Also, there was a significant relationship between vaginal bleeding and sexual violence (P = 0.022). Educational level significantly and inversely correlated with economic (r = -0.21) and physical (r = -0.19) violence.

The results of this study indicated that intimate partner violence was commonplace during pregnancy and affected neonatal and maternal outcomes. It is suggested to implement educational programs for healthcare workers and screen all pregnant women for exposure to intimate partner violence to reduce maternal and neonatal complications.

 Social factors which are integrated with health status are considered crucial in pregnancy morbidity. Mothers with a developed level of health literacy (HL) experience a lower risk of preterm delivery. This study aimed to evaluate the relationship between maternal HL and prenatal care and pregnancy outcome.

The research was a cohort study. A total of 323 participants were selected from prenatal clinics. The women were followed until delivery. Women who had gestational diabetes or preeclampsia or gestational hypertension during pregnancy were omitted. Data were collected with a survey.

 The result found 34.1%, 33.1%, 23.8%, and 9% were categorized as having inadequate, problematic, sufficient, and excellent maternal HL. Women with sufficient and excellent literacy were meaningfully better in having earlier and more frequent antenatal care, earlier folic acid consumption, and exercise before and during pregnancy, pregnancy alarm sign awareness, neonatal birth weight, and breastfeeding.

The results proposed that sufficient and excellent HL among women is related to good pregnancy outcomes and poor HL causes a poor chance to gain a positive pregnancy outcome. A cooperative work to grow maternal HL by considering HL levels, revision of educational materials into plain language, and provision of pregnant women with verbal and video instruction in addition to written materials are highly recommended.

Lipoblastoma is one of the rare masses in childhood and its diagnosis is very uncommon in the perinatal period, so we reported a case with a diagnosis of this mass during pregnancy.

In a routine third-trimester ultrasound at 28 weeks, a hyperechoic mass in the size of 27*30mm was detected in between labia majora. However, no abnormal findings were found in perinatal care before this gestational age. Finally, after the birth, at 40 weeks of gestation, the mass was resected and now the baby is in good condition and no recurrence has occurred. There was also an anorectal anomaly associated with this mass in our patient who underwent Anorectoplasty surgery.

Due to the rarity of these tumors, it is important to diagnose them in the perinatal period and to investigate other associated anomalies.

 Predicting preterm delivery can help obstetricians and midwives for better management of pregnancy care. Therefore, we aimed to investigate the relationship between cervical length and uteroservical angle with the occurrence of preterm delivery.

The present cohort study was conducted on 100 pregnant women with singleton pregnancy referred for routine control to perinatology ward of Imam Khomeini Hospital in Tehran between Jan 2019-Apr, 2019. All included cases were undergoing transvaginal sonography to measure the anterior cervical angle and length. Maternal demographic and clinical data, as well as delivery data of pregnant women, were obtained from their medical records. Logistic regression was conducted to estimate the predictors of pre-term delivery. All analyses were performed using Stata 14.0.

Among 100 pregnant women, 17 had preterm delivery. Pregnant women with bleeding during pregnancy were reported with a higher preterm delivery rate (23.53% vs. 4.82%) (P=0.01). The difference of mean cervical angle between pregnant women with the term and preterm delivery was statistically different (102.12° in women who delivered pre-term vs. 86.15° in term group, P<0.001).

According to the results, pregnant women with bleeding during pregnancy and those with a higher mean of cervical angle were more prone to pre-term delivery. Therefore, the anterior cervical angle and bleeding during pregnancy can be considered as predictors for preterm birth.

Anticoagulant therapy has been used for the prevention and treatment of deep vein thrombosis and pulmonary embolism. Heparin-induced necrotizing skin lesion is a serious complication that can be potentially life-threatening.

Case Report: 

We report a 55-year-old female presenting with skin necrosis without thrombocytopenia after prescribing heparin prophylaxis. She had died as it was not possible to discontinue her heparin therapy.

Heparin-induced skin necrosis should be suspected in all patients who undergo UFH or LMWH. Observation of platelet count is recommended at the onset of skin lesions. Early diagnosis of this condition can be helpful for the management of this potentially mortal disease.

The present study proposes to examine the factors that influence the formation of Iranophobia in Afghanistan and ways and means of dealing with it as well as to seek the answer to the key question: What are the most important factors influencing the formation of Iranophobia in Afghanistan after the US invasion? The hypothesis raised in response to the above question is that: Anti-Iranian policies of the transnational (mainly US) and regional (mainly Saudi Arabia) countries are the main cause of the formation and spread of Iranophobia in Afghanistan. On the other hand, Iran’s cohesive and sometimes inaccurate policies towards Afghan refugees have also been cited as facilitating Iran’s fear in Afghanistan. Using the content of four newspapers published in Afghanistan in 1986 and 1977, we discuss some of Iranophobia. We shall, then, proceed to examine the most important factors affecting it and in the end, we will present some solutions to counter the existing atmosphere of Iranophobia in Afghanistan.

A significant increase in cesarean section in worldwide is known as one of the health system problems. The WHO has estimated that cesarean section in recent years has been 10% in all countries. Despite the increasing popularity of cesarean section, the literature lacks insights about factors affecting the selection of this delivery method. In this vein, this study investigates the factors affecting the choice of cesarean-section from the perspective of pregnant women.

The sample of this descriptive and analytical study is 200 pregnant women selected using simple random sampling method in Kosar Hospital in Qazvin Province, Iran. The survey questionnaire was used for data collection from March to September of 2017. In order to evaluate the validity and reliability of the research, expert’s opinion and Cronbach alpha coefficient have been used. The questionnaire included scales designed to measure effective factor. Statistical package for social science software (SPSS) version 22 (SPSS Inc., Chicago, IL, USA) were used to analyses the data. T-test and ANOVA were used to compare groups.

The results of prioritizing the items in terms of psychological factors showed that the statements “I am afraid of the pain of normal labor” and “I feel higher stress and anxiety with natural labor were the first priorities”. There was no significant difference between pregnant women who had previous experience and those who did not have a delivery experience. The results of the mean comparison test showed no significant difference between the attitudes of women with previous delivery experience and women who did not have a delivery experience. There were only differences between socio-cultural factors (P= 0.004), factors related to delivery conditions (P= 0.001), consequences of delivery (P= 0.017) among pregnant women with different levels of training.

The results of this study revealed that there is a difference between the attitudes of pregnant women and different levels of education, so pre-pregnancy training should be provided to pregnant women

Labor induction is one of the most public ways carried out global for delivering mothers. The aim of labor induction is to encourage uterine contractions before the spontaneous onset of labor, resultant in vaginal delivery misoprostol is used off-label for a variety of indications in the practice of obstetrics and gynecology, including medication abortion, medical management of miscarriage, induction of labor, cervical ripening before surgical procedures, and the treatment of postpartum hemorrhage. Regarding the importance and lack of similar researches in Iran, this research was done to compare the efficacy of buccal and sublingual misoprostol for labor induction in pregnant women.
This study was conducted as a randomized double-blind clinical trial from March 2017 to February 2018. In this survey, 200 women were randomly assigned to receive 50 µg buccal misoprostol and sublingual (100 buccal and 100 sublingual) in Kosar Hospital, Qazvin University of Medical Sciences, Iran. The maternal and fetal complications, Bishop score, and time of pain onset and its interval with labor were monitored in two groups and the findings were analyzed.
Research variables were age, gestational age, BMI, number of previous pregnancy, neonatal weight, total dose, Bishop score 1, Bishop score 6, oxytocin, and delivery type. The results showed that there were no differences between Bishop score 6 (P=0.07), and 1 (P=0.36), total dose (P=0.58), neonatal weight (P=0.43), number of pregnancy (P=0.67), BMI (P=0.67), and pregnancy weak (P=0.108) of sublingual group and buccal group. About 43 patients (43%) in buccal and 64 (64%) in sublingual group had vaginal delivery (P=0.05). The frequencies of maternal and fetal complications were similar between two groups.
It can be concluded that there is no difference between efficacy of sublingual and buccal misoprostol in pregnancy results, maternal, and fetal complications, however, it seems that the sublingual group is more effective than buccal group due to the significant amount of vaginal delivery, achieving vaginal delivery in less than 24 hours, and less need for oxytocin.

One of the essential issues in doctor-patient relationship is the matter of telling the truth of cancer diagnosis to patients. This is not only important from an ethical standpoint, but also can have legal implications. Thus, truth-telling and its associated factors are of great importance especially in cancer patients. The aim of this study was to evaluate factors effective in doctors’ telling the truth to their patients.
The statistical population included specialists and subspecialists working in the field of cancer treatment in Tehran. Overall, 161 questionnaires, designed for our study, were gathered and evaluated.
According to our study, 87.6% of the responders would tell the truth to their patients, while 12.4% wouldnt do so. They believed that the best person to tell the truth to the patient is the physician or the psychiatrist specialized in this field. Ninety-two percent of physicians felt the need for developing a guideline on educating patients. There was a significant difference between oncologists and non-oncologists in terms of tendency to tell the truth, with non-oncologists showing more tendency. Most of the doctors preferred to tell the truth to their middle-aged (51–70 years) patients rather than to their younger or older patients.
Only 25.5% of physicians in our study had the policy to tell the truth to the majority of their patients, and almost all of them felt the need for having a formal guideline regarding informing and educating cancer patients. This highlights the significance of cultural-religious context of our country and the importance of having a practical guideline to educate our physicians.

Cancer is a major life-threatening disease that can evoke deep-rooted fear of death and sense of loss of hope. Even the word, cancer, has powerful connotations of anxiety, pain and suffering. Cancer has a great impact on patients’ lives, so the extent to which physicians should inform them of the diagnosis poses a difficult decision in clinical settings. Therefore, truth telling is one of the most important issues in patients- physicians’ relationship. Besides the ethical aspect, telling or not telling the truth has some legal aspects, therefore, it is important to know the effective factors and understand how to deal with this issue especially for incurable diseases such as cancer. Therefore, the aim of this research was to analyses the effective factors in physician’s truth telling to cancer-patients.
The samples of this descriptive and analytical study, (survey study) consist of 161 cancer-specialists from Tehran University of Medical Sciences who have been selected by simple random sampling method in 2015 and 2016. The data was obtained by survey approach and the data collected using a questionnaire. In order to evaluate the validity and reliability of the research, expert’s opinion and Cronbach alpha coefficient have been used. The questionnaire included scales designed to measure attitude, intention, subjective norms; perceived behavior control. Statistical package for social science software (SPSS) were used to analyses the data. T-test and ANOVA were used to compare groups.
Fifty-nine hudred percent male and 41% female physicians took part in this study. The average age of the participants was 43.4±11.27 years. The best person for truth-telling was physician and psychologist. Results showed that there was no significant difference between attitudes of male and female specialist but there was significant difference between oncologist and non-oncologist tendency to tell the truth. Results also showed that there was difference between physician’s behaviors (average 8.87). There was difference between behavior of private and public-private sectors physicians (62.8).
Although the results show that there are differences in specialists’ attitude toward truth telling, it is not a good reason for not telling the truth. Although the physicians should consider several factors when telling the truth.

Weigh In Motion system (WIM) is known as an important component of ITS, its usage is increasingly to be applied for axle load enforcement. Huge investment in construction and maintenance of pavement leads policy makers to tackle overloading using weigh in motion systems. Installing weight in motion system is a high investing constructive project in terms of needed special pavement, electronic devices, and data transferring device and human resource to overloading reduction and save pavement condition in proper situation. Following the above mentioned, it is necessary to be a trade-off consideration between pavement cost repairing and installing weigh in motion system. So in this research will be presented on the basis of break-even at the cost of purchase, installation, operating and maintenance costs of the system and saves the cost to repair the pavement as the top model in terms of income. The average overloaded axles under enforcement performed by authorities to tackle overloading is studied a criterion and the proposed model determines the minimum average overloaded axes in which installing WIM would be an economic project. Although, the proposed model is designed as a parametric pattern, but an installed WIM system has been selected as case study and the number of required enforcement calculated. Results of this study will help decision-makers in the field of transport, as in the operation of WIM to achieve a balance between costs and revenues from it the right decision to take.

Truth-telling is considered as an important topic of modern discussion regarding the physician-patient relationship. The present study examined the behavior of physicians in disclosing the truth to patients. For this purpose، a total of 161 cancer specialists were selected using the simple random sampling technique. Research instrument consisted of a 24-item questionnaire based on expert opinion and the review of related literature. The results of item prioritization indicated that the participants ranked the following two items as highest in terms of attitude: «It is the basic right of patients to know about their condition»، and «Relatives'' participation in disclosing the truth to patients is rather beneficial». Research results also showed a positive and significant correlation between attitude and truth-telling tendency. Furthermore، multiple regression analysis by SMART-PLS software demonstrated that perceived behavioral control (self-efficiency) has the greatest impact on physicians'' tendency toward truth-telling. The prediction power of planned behavior theory in predicting physicians'' truth-telling behavior was established at 92 percent. Based on these findings، it is recommended to employ experts and adopt relevant guidelines to train novice physicians. Moreover، Iranian health officials are advised to take corrective measures to improve physicians'' attitudes and subjective norms.